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Wright DR, Chen T, Chalmers KD, Shah SK, Yi-Frazier JP, LeBlanc JL, Garvey K, Senturia KD, Pihoker C, Malik FS. Adolescent-Preferred financial incentives to promote type 1 diabetes Self-Care: A discrete choice experiment. Diabetes Res Clin Pract 2024; 215:111798. [PMID: 39096938 DOI: 10.1016/j.diabres.2024.111798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2024] [Revised: 07/12/2024] [Accepted: 07/28/2024] [Indexed: 08/05/2024]
Abstract
AIMS This study aimed to quantify preferences for the characteristics of a financial incentives program that would motivate adolescent engagement in type 1 diabetes (T1D) self-care. METHOD We performed a discrete choice experiment with 12-18 year-olds with T1D from two pediatric hospital endocrinology clinics (n = 317). We identified key attributes of incentives: (1) monthly value of the reward, (2) payment structure, and (3) difficulty of incentivized behaviors. In twelve choice questions, adolescents chose the incentive option from a pair of profiles that was more likely to motivate them to increase adherence to recommended self-care. Options presented were tailored to adolescents' T1D technology use and perceived difficulty of completing each behavior. We analyzed data using a conditional logit model. RESULTS The value of the reward accounted for 60.8% of preferences. Adolescents were willing to accept lower value rewards when incentive payments used positive vs. negative reinforcement (-$10.88 (95% CI: -$12.60, -9.24)) and preferred higher incentives for performing hard vs. easier behaviors (+$14.92 (95% CI: +$12.66, +$17.28)). CONCLUSIONS Stated preferences can inform intervention design. Future research will evaluate the external validity of the discrete choice experiment-informed intervention design by assessing adolescent health and behavioral outcomes in a randomized controlled trial.
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Affiliation(s)
- Davene R Wright
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA.
| | - Tom Chen
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA
| | | | - Seema K Shah
- Department of Pediatrics, Northwestern University School of Medicine, Chicago, IL, USA; Smith Child Health Outreach, Research, and Evaluation Center, Stanley Manne Children's Research Institute, Lurie Children's Hospital, Chicago, IL, USA
| | - Joyce P Yi-Frazier
- Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, MA USA
| | - Jessica L LeBlanc
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA
| | - Katharine Garvey
- Division of Endocrinology, Boston Children's Hospital, Boston, MA, USA
| | - Kirsten D Senturia
- Seattle Children's Research Institute, Seattle, WA, USA; University of Washington, Seattle, WA, USA
| | - Catherine Pihoker
- Seattle Children's Research Institute, Seattle, WA, USA; University of Washington, Seattle, WA, USA
| | - Faisal S Malik
- Seattle Children's Research Institute, Seattle, WA, USA; University of Washington, Seattle, WA, USA
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Wu Y, Long TX, Huang J, Zhang Q, Forbes A, Li MZ. Delivering a Smartphone Serious Game-Based Intervention to Promote Resilience for Adolescents With Type 1 Diabetes: A Feasibility Study. J Pediatr Health Care 2024:S0891-5245(24)00139-1. [PMID: 38935014 DOI: 10.1016/j.pedhc.2024.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2024] [Revised: 04/16/2024] [Accepted: 05/28/2024] [Indexed: 06/28/2024]
Abstract
INTRODUCTION The aim of this study is to test the feasibility of a smartphone serious game-based intervention to promote resilience for adolescents with type 1 diabetes mellitus (T1DM). METHOD A two-arm feasibility study was employed. Adolescents with T1DM were recruited. Adolescents in intervention group completed the serious game (named "WeCan") in one month. We evaluated feasibility and acceptability using criteria such as the recruitment response rate, the follow-up response rate, and satisfaction. RESULTS Sixty-one adolescents with T1DM were included in this study. The study had a recruitment response rate of 62.89% (61/97) and an intervention completion rate of 64.52% (20/31). Eighty-two percent of the adolescents were satisfied with WeCan, which they perceived to have the advantages of being a lively format, attractive, and privacy, easy to operate, and improved attitude towards diabetes. CONCLUSIONS These findings suggest that WeCan demonstrated good feasibility among the target population. However, the efficacy of health-related outcomes needs to be clarified in future studies.
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Novak MD, Holtyn AF, Toegel F, Rodewald AM, Leoutsakos JM, Fingerhood M, Silverman K. Long-Term Effects of Incentives for HIV Viral Suppression: A Randomized Clinical Trial. AIDS Behav 2024; 28:625-635. [PMID: 38117449 DOI: 10.1007/s10461-023-04249-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/08/2023] [Indexed: 12/21/2023]
Abstract
Achieving viral suppression in people living with HIV improves their quality of life and can help end the HIV/AIDS epidemic. However, few interventions have successfully promoted HIV viral suppression. The purpose of this study was to evaluate the long-term effectiveness of financial incentives for viral suppression in people living with HIV. People living with a detectable HIV viral load (≥ 200 copies/mL) were randomly assigned to Usual Care (n = 50) or Incentive (n = 52) groups. Incentive participants earned up to $10 per day for providing blood samples with an undetectable or reduced viral load. During the 2-year intervention period, the percentage of blood samples with a suppressed viral load was significantly higher among Incentive participants (70%) than Usual Care participants (43%) (OR = 7.1, 95% CI 2.7 to 18.8, p < .001). This effect did not maintain after incentives were discontinued. These findings suggest that frequent delivery of large-magnitude financial incentives for viral suppression can produce large and long-lasting improvements in viral load in people living with HIV. ClinicalTrials.gov Identifier: NCT02363387.
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Affiliation(s)
- Matthew D Novak
- Department of Psychiatry and Behavioral Sciences, Center for Learning and Health, Johns Hopkins University School of Medicine, 5200 Eastern Avenue, Suite 350 East, Baltimore, MD, 21224, USA
| | - August F Holtyn
- Department of Psychiatry and Behavioral Sciences, Center for Learning and Health, Johns Hopkins University School of Medicine, 5200 Eastern Avenue, Suite 350 East, Baltimore, MD, 21224, USA
| | - Forrest Toegel
- Department of Psychiatry and Behavioral Sciences, Center for Learning and Health, Johns Hopkins University School of Medicine, 5200 Eastern Avenue, Suite 350 East, Baltimore, MD, 21224, USA
| | - Andrew M Rodewald
- Department of Psychiatry and Behavioral Sciences, Center for Learning and Health, Johns Hopkins University School of Medicine, 5200 Eastern Avenue, Suite 350 East, Baltimore, MD, 21224, USA
| | - Jeannie-Marie Leoutsakos
- Department of Psychiatry and Behavioral Sciences, Center for Learning and Health, Johns Hopkins University School of Medicine, 5200 Eastern Avenue, Suite 350 East, Baltimore, MD, 21224, USA
| | - Michael Fingerhood
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Kenneth Silverman
- Department of Psychiatry and Behavioral Sciences, Center for Learning and Health, Johns Hopkins University School of Medicine, 5200 Eastern Avenue, Suite 350 East, Baltimore, MD, 21224, USA.
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4
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Regnier SD, Shellenberg TP, Koffarnus MN, Cox DH, Lile JA, Rush CR, Stoops WW. Cocaine abstinence during the "critical period" of a contingency management trial predicts future abstinence in people with cocaine use disorder. Drug Alcohol Depend 2023; 253:111030. [PMID: 38006674 PMCID: PMC10841665 DOI: 10.1016/j.drugalcdep.2023.111030] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 11/08/2023] [Accepted: 11/09/2023] [Indexed: 11/27/2023]
Abstract
BACKGROUND Contingency Management (CM) is being piloted as a treatment for stimulant use disorder in several US states, highlighting the need for treatment optimization. One important goal of optimization is decreasing drug use during the early stages of treatment, which has predicted success in other interventions. However, this "critical period" has not been reported in CM trials. The purpose of this analysis was to determine if, after accounting for baseline abstinence and incentive condition, abstinence in a CM trial for people with Cocaine Use Disorder (CUD) could be predicted by cocaine use during a first-week critical period. METHODS Eighty-seven participants with CUD were randomized to receive contingent high or low value incentives for cocaine abstinence or were in a non-contingent control group. Generalized estimating equations (GEE) were used to analyze urine test results over 36 timepoints during the 12-week intervention. To assess for a critical period, the first three visits were included in the GEE as a covariate for remaining urine test results. RESULTS Participants who provided more negative samples during the critical period were significantly more likely to produce a negative urine sample during the remainder of the trial, though some effects of group remained after controlling for the critical period. CONCLUSIONS These results indicate that a critical period exists for CM trials, and it can explain a substantial amount of future performance. Early contact with an abstinence-contingent high magnitude alternative reinforcer may explain additional performance beyond the critical period, further justifying the use of high magnitude alternative reinforcers.
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Affiliation(s)
- Sean D Regnier
- Department of Behavioral Science, University of Kentucky College of Medicine, Medical Behavioral Science Building, 1100 Veterans Drive, Lexington, KY 40536-0086, USA
| | - Thomas P Shellenberg
- Department of Behavioral Science, University of Kentucky College of Medicine, Medical Behavioral Science Building, 1100 Veterans Drive, Lexington, KY 40536-0086, USA; Department of Psychology, University of Kentucky College of Arts and Sciences, 171. Funkhouser Drive, Lexington, KY 40506-0044, USA
| | - Mikhail N Koffarnus
- Department of Family & Community Medicine, University of Kentucky College of Medicine, 2195 Harrodsburg Road, Lexington, KY 40504, USA
| | - David H Cox
- Department of Behavioral Science, University of Kentucky College of Medicine, Medical Behavioral Science Building, 1100 Veterans Drive, Lexington, KY 40536-0086, USA
| | - Joshua A Lile
- Department of Behavioral Science, University of Kentucky College of Medicine, Medical Behavioral Science Building, 1100 Veterans Drive, Lexington, KY 40536-0086, USA; Department of Psychiatry, University of Kentucky College of Medicine, 245 Fountain Court, Lexington, KY 40509-1810, USA; Department of Psychology, University of Kentucky College of Arts and Sciences, 171. Funkhouser Drive, Lexington, KY 40506-0044, USA
| | - Craig R Rush
- Department of Behavioral Science, University of Kentucky College of Medicine, Medical Behavioral Science Building, 1100 Veterans Drive, Lexington, KY 40536-0086, USA; Department of Psychiatry, University of Kentucky College of Medicine, 245 Fountain Court, Lexington, KY 40509-1810, USA; Department of Psychology, University of Kentucky College of Arts and Sciences, 171. Funkhouser Drive, Lexington, KY 40506-0044, USA
| | - William W Stoops
- Department of Behavioral Science, University of Kentucky College of Medicine, Medical Behavioral Science Building, 1100 Veterans Drive, Lexington, KY 40536-0086, USA; Department of Psychiatry, University of Kentucky College of Medicine, 245 Fountain Court, Lexington, KY 40509-1810, USA; Department of Psychology, University of Kentucky College of Arts and Sciences, 171. Funkhouser Drive, Lexington, KY 40506-0044, USA; Center on Drug and Alcohol Research, University of Kentucky College of Medicine, 845 Angliana Ave, Lexington, KY 40508, USA.
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5
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Zafra‐Tanaka JH, Beran D, Bernabe‐Ortiz A. Health system responses for type 1 diabetes: A scoping review. Diabet Med 2022; 39:e14805. [PMID: 35124856 PMCID: PMC9306957 DOI: 10.1111/dme.14805] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 02/03/2022] [Indexed: 11/29/2022]
Abstract
AIMS The focus of health system interventions for noncommunicable diseases and diabetes focus mainly on primary health care responses. However, existing interventions are not necessarily adapted for the complex management of type 1 diabetes (T1DM). We aimed to identify and describe health system interventions which have been developed to improve the management of T1DM globally. METHODS We conducted a scoping review by searching MEDLINE, Embase, and Global Health using OVID for peer-review articles published in either English, Spanish, Portuguese or French in the last 10 years. We classified the intervention strategies according to the Effective Practice and Organization of Care (EPOC) taxonomy for health system interventions and the World Health Organization (WHO) health system building blocks. RESULTS This review identified 159 health system interventions to improve T1DM management. Over half of the studies focused only on children or adolescents with type 1 diabetes. Only a small fraction of the studies were conducted in low-and-middle income countries (LMICs). According to the EPOC taxonomy, the most frequently studied category was delivery arrangement interventions, while implementation strategies and financial arrangements were less frequently studied. Also, governance arrangements domains were not studied. The most common combination of intervention strategies included self-management with either telemedicine, use of information and smart home technologies. CONCLUSIONS There is a need to expand potential interventions to other EPOC strategies to assess their potential effect on health outcomes in people with T1DM, as well as to involve more LMIC settings as the impact may be greater in these settings.
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Affiliation(s)
- Jessica H. Zafra‐Tanaka
- CRONICAS Center of Excellence in Chronic DiseasesUniversidad Peruana Cayetano HerediaLimaPeru
- Division of Tropical and Humanitarian MedicineUniversity of Geneva and Geneva University HospitalsGenevaSwitzerland
| | - David Beran
- Division of Tropical and Humanitarian MedicineUniversity of Geneva and Geneva University HospitalsGenevaSwitzerland
| | - Antonio Bernabe‐Ortiz
- CRONICAS Center of Excellence in Chronic DiseasesUniversidad Peruana Cayetano HerediaLimaPeru
- Universidad Científica del SurLimaPeru
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Patton SR, Cushing CC, Lansing AH. Applying Behavioral Economics Theories to Interventions for Persons with Diabetes. Curr Diab Rep 2022; 22:219-226. [PMID: 35267141 PMCID: PMC9951181 DOI: 10.1007/s11892-022-01460-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/31/2022] [Indexed: 01/28/2023]
Abstract
PURPOSE OF REVIEW To introduce behavioral economics (BE), provide a description of how recent prevention and treatment interventions in persons with diabetes have incorporated BE in their intervention strategies, and discuss how BE could be used to inform new treatments for the clinical setting or research. RECENT FINDINGS In most of the trials described, researchers incorporated BE into their design in the form of incentives, which can align with present bias, optimism bias, and loss aversion. With only two exceptions, these trials reported preliminary support for using incentives to promote lifestyle modifications and diabetes-related tasks. Additionally, two trials reported promising results for behavior change strategies informed by default bias, while three trials reported promising results for behavior change strategies informed by social norms. Recent trials incorporating BE in prevention and treatment interventions for persons with diabetes generally report promising results, though gaps exist for research and clinical deployment.
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Affiliation(s)
- Susana R Patton
- Center for Healthcare Delivery Science, Nemours Children's Health, 807 Children's Way, Jacksonville, FL, 32207, USA.
| | - Christopher C Cushing
- Clinical Child Psychology Program, University of Kansas, 2011 Dole Human Development Center, 1000 Sunnyside Avenue, Lawrence, KS, 66045, USA
| | - Amy Hughes Lansing
- Department of Psychological Science, University of Vermont, John Dewey Hall, 2 Colchester Avenue, Burlington, VT, 05401, USA
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7
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Raiff BR, Burrows C, Dwyer M. Behavior-Analytic Approaches to the Management of Diabetes Mellitus: Current Status and Future Directions. Behav Anal Pract 2021; 14:240-252. [PMID: 33732594 PMCID: PMC7900358 DOI: 10.1007/s40617-020-00488-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Diabetes mellitus is the seventh leading cause of death in the United States, requiring a series of complex behavior changes that must be sustained for a lifetime (e.g., counting carbohydrates, self-monitoring blood glucose, adjusting insulin). Although complex, all of these tasks involve behavior, making them amenable targets for behavior analysts. In this article, the authors describe interventions that have focused on antecedent, consequent, multicomponent, and alternate procedures for the management of diabetes, highlighting ways in which technology has been used to overcome common barriers to the use of these intensive, evidence-based interventions. Additional variables relevant to poorly managed diabetes (e.g., delay discounting) are also discussed. Future research and practice should focus on harnessing continued advances in information technology while also considering underexplored behavioral technologies for the effective treatment of diabetes, with a focus on identifying sustainable, long-term solutions for maintaining proper diabetes management. Practical implementation of these interventions will depend on having qualified behavior analysts working in integrated primary care settings where the interventions are most likely to be used, which will require interdisciplinary training and collaboration.
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Affiliation(s)
- Bethany R. Raiff
- Department of Psychology, Rowan University, 201 Mullica Hill Road, Glassboro, NJ 08028 USA
| | - Connor Burrows
- Department of Psychology, Rowan University, 201 Mullica Hill Road, Glassboro, NJ 08028 USA
| | - Matthew Dwyer
- Department of Psychology, Rowan University, 201 Mullica Hill Road, Glassboro, NJ 08028 USA
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Stanger C, Kowatsch T, Xie H, Nahum-Shani I, Lim-Liberty F, Anderson M, Santhanam P, Kaden S, Rosenberg B. A Digital Health Intervention (SweetGoals) for Young Adults With Type 1 Diabetes: Protocol for a Factorial Randomized Trial. JMIR Res Protoc 2021; 10:e27109. [PMID: 33620330 PMCID: PMC7943343 DOI: 10.2196/27109] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 01/14/2021] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Many young adults with type 1 diabetes (T1D) struggle with the complex daily demands of adherence to their medical regimen and fail to achieve target range glycemic control. Few interventions, however, have been developed specifically for this age group. OBJECTIVE In this randomized trial, we will provide a mobile app (SweetGoals) to all participants as a "core" intervention. The app prompts participants to upload data from their diabetes devices weekly to a device-agnostic uploader (Glooko), automatically retrieves uploaded data, assesses daily and weekly self-management goals, and generates feedback messages about goal attainment. Further, the trial will test two unique intervention components: (1) incentives to promote consistent daily adherence to goals, and (2) web health coaching to teach effective problem solving focused on personalized barriers to self-management. We will use a novel digital direct-to-patient recruitment method and intervention delivery model that transcends the clinic. METHODS A 2x2 factorial randomized trial will be conducted with 300 young adults ages 19-25 with type 1 diabetes and (Hb)A1c ≥ 8.0%. All participants will receive the SweetGoals app that tracks and provides feedback about two adherence targets: (a) daily glucose monitoring; and (b) mealtime behaviors. Participants will be randomized to the factorial combination of incentives and health coaching. The intervention will last 6 months. The primary outcome will be reduction in A1c. Secondary outcomes include self-regulation mechanisms in longitudinal mediation models and engagement metrics as a predictor of outcomes. Participants will complete 6- and 12-month follow-up assessments. We hypothesize greater sustained A1c improvements in participants who receive coaching and who receive incentives compared to those who do not receive those components. RESULTS Data collection is expected to be complete by February 2025. Analyses of primary and secondary outcomes are expected by December 2025. CONCLUSIONS Successful completion of these aims will support dissemination and effectiveness studies of this intervention that seeks to improve glycemic control in this high-risk and understudied population of young adults with T1D. TRIAL REGISTRATION ClinicalTrials.gov NCT04646473; https://clinicaltrials.gov/ct2/show/NCT04646473. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) PRR1-10.2196/27109.
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Affiliation(s)
- Catherine Stanger
- Center for Technology and Behavioral Health, Geisel School of Medicine, Dartmouth College, Lebanon, NH, United States
| | - Tobias Kowatsch
- Centre for Digital Health Interventions, Department of Management, Technology, and Economics, ETH Zurich, Zurich, Switzerland.,Centre for Digital Health Interventions, Institute of Technology Management, University of St Gallen, St Gallen, Switzerland
| | - Haiyi Xie
- Center for Technology and Behavioral Health, Geisel School of Medicine, Dartmouth College, Lebanon, NH, United States
| | - Inbal Nahum-Shani
- Institute for Social Research, University of Michigan, Ann Arbor, MI, United States
| | | | - Molly Anderson
- Center for Technology and Behavioral Health, Geisel School of Medicine, Dartmouth College, Lebanon, NH, United States
| | - Prabhakaran Santhanam
- Centre for Digital Health Interventions, Department of Management, Technology, and Economics, ETH Zurich, Zurich, Switzerland
| | - Sarah Kaden
- Center for Technology and Behavioral Health, Geisel School of Medicine, Dartmouth College, Lebanon, NH, United States
| | - Briana Rosenberg
- Center for Technology and Behavioral Health, Geisel School of Medicine, Dartmouth College, Lebanon, NH, United States
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9
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Chaytor NS, Barbosa-Leiker C, Germine LT, Fonseca LM, McPherson SM, Tuttle KR. Construct validity, ecological validity and acceptance of self-administered online neuropsychological assessment in adults. Clin Neuropsychol 2021; 35:148-164. [PMID: 32883156 PMCID: PMC8982107 DOI: 10.1080/13854046.2020.1811893] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Revised: 08/12/2020] [Accepted: 08/13/2020] [Indexed: 12/29/2022]
Abstract
Objective: The goal of this project was to explore the initial psychometric properties (construct and ecological validity) of self-administered online (SAO) neuropsychological assessment (using the www.testmybrain.org platform), compared to traditional testing, in a clinical sample, as well as to evaluate participant acceptance. SAO assessment has the potential to expand the reach of in-person neuropsychological assessment approaches.Method: Counterbalanced, within-subjects design comparing SAO performance to in-person performance in adults with diabetes with and without Chronic Kidney Disease (CKD). Forty-nine participants completed both assessment modalities (type 1 diabetes N = 14, type 2 diabetes N = 35; CKD N = 18).Results: Associations between SAO and analogous in-person tests were adequate to good (r = 0.49-0.66). Association strength between divergent cognitive tests did not differ between SAO versus in-person tests. SAO testing was more strongly associated with age than in-person testing (age R2=0.54 versus 0.23), while prediction of education, HbA1c, and estimated glomerular filtration rate (eGFR) did not differ significantly between test modalities (education R2=0.37 versus 0.30; HbA1c R2=0.20 versus 0.12; eGFR R2 = 0.41 versus 0.33). Associations with measures of everyday functioning were also similar (Functional Activities Questionnaire R2=0.08 versus 0.07; Neuro-QoL R2=0.14 versus 0.16; Diabetes Self-Management Questionnaire R2=0.19 versus 0.19).Conclusions: The selected SAO neuropsychological tests had acceptable construct validity (including divergent, convergent, and criterion-related validity), and similar ecological validity to that of traditional testing. These SAO assessments were acceptable to participants and appear appropriate for use in research applications, although further research is needed to better understand the strengths and weaknesses in other clinical populations.
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Affiliation(s)
- Naomi S Chaytor
- WSU Health Sciences Spokane, Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, USA
| | | | - Laura T Germine
- Institute for Technology in Psychiatry, McLean Hospital, Belmont, MA, USA
- Psychiatry Department, Harvard Medical School, Boston, MA, USA
| | - Luciana Mascarenhas Fonseca
- WSU Health Sciences Spokane, Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, USA
| | - Sterling M McPherson
- WSU Health Sciences Spokane, Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, USA
- School of Medicine, University of Washington, Seattle, WA, USA
- Providence Health Care, Spokane, WA, USA
| | - Katherine R Tuttle
- School of Medicine, University of Washington, Seattle, WA, USA
- Providence Health Care, Spokane, WA, USA
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10
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Ellis JD, Struble CA, Fodor MC, Cairncross M, Lundahl LH, Ledgerwood DM. Contingency management for individuals with chronic health conditions: A systematic review and meta-analysis of randomized controlled trials. Behav Res Ther 2020; 136:103781. [PMID: 33302054 DOI: 10.1016/j.brat.2020.103781] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 10/24/2020] [Accepted: 11/16/2020] [Indexed: 01/28/2023]
Abstract
BACKGROUND Contingency management (CM) interventions involve providing reinforcement for engaging in a desired behavior, and have been shown to increase treatment adherence and promote abstinence in the treatment of substance use disorders. This review was conducted to systematically review the literature on the effectiveness of CM when applied to a range of medical conditions outside of substance use disorders. METHOD The authors identified a total of 24 randomized studies examining the effects of CM on four outcomes: weight change, physical activity, medication/device adherence, and viral load that were included in the qualitative summary, and 20 studies included in the meta-analysis. RESULTS CM was associated with positive outcomes for physical activity and medication/device adherence compared to control conditions. Findings with weight loss and viral load were more mixed, and evidence for publication bias was found for both outcomes. The effects of CM tend to dissipate when the contingency is removed. Heterogeneity was observed across most outcomes. LIMITATIONS AND CONCLUSIONS This review provides preliminary support for the use of CM in increasing physical activity and improving adherence to medication for chronic health conditions while reinforcement is ongoing. Future studies should examine potential moderators and identify strategies to maintain these changes over time.
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Affiliation(s)
- Jennifer D Ellis
- Department of Psychiatry & Behavioral Neurosciences, Wayne State University, USA; Department of Psychiatry & Behavioral Sciences, Johns Hopkins University, USA
| | - Cara A Struble
- Department of Psychiatry & Behavioral Neurosciences, Wayne State University, USA
| | - Marina C Fodor
- Department of Psychiatry & Behavioral Neurosciences, Wayne State University, USA
| | - Molly Cairncross
- Division of Physical Medicine and Rehabilitation, The University of British Columbia, Canada
| | - Leslie H Lundahl
- Department of Psychiatry & Behavioral Neurosciences, Wayne State University, USA
| | - David M Ledgerwood
- Department of Psychiatry & Behavioral Neurosciences, Wayne State University, USA.
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11
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Turnbull S, Cabral C, Hay A, Lucas PJ. Health Equity in the Effectiveness of Web-Based Health Interventions for the Self-Care of People With Chronic Health Conditions: Systematic Review. J Med Internet Res 2020; 22:e17849. [PMID: 32459632 PMCID: PMC7305554 DOI: 10.2196/17849] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Revised: 03/27/2020] [Accepted: 03/29/2020] [Indexed: 12/17/2022] Open
Abstract
Background Web-based self-care interventions have the potential to reduce health inequalities by removing barriers to access to health care. However, there is a lack of evidence about the equalizing effects of these interventions on chronic conditions. Objective This study investigated the differences in the effectiveness of web-based behavioral change interventions for the self-care of high burden chronic health conditions (eg, asthma, chronic obstructive pulmonary disease [COPD], diabetes, and osteoarthritis) across socioeconomic and cultural groups. Methods A systematic review was conducted, following Cochrane review guidelines. We conducted searches in Ovid Medical Literature Analysis and Retrieval System Online and Cumulative Index to Nursing and Allied Health Literature databases. Studies with any quantitative design were included (published between January 1, 2006, and February 20, 2019) if they investigated web-based self-care interventions targeting asthma, COPD, diabetes, and osteoarthritis; were conducted in any high-income country; and reported variations in health, behavior, or psychosocial outcomes across social groups. Study outcomes were investigated for heterogeneity, and the possibility of a meta-analysis was explored. A narrative synthesis was provided together with a novel figure that was developed for this review, displaying heterogeneous outcomes. Results Overall, 7346 records were screened and 18 studies were included, most of which had a high or critical risk of bias. Important study features and essential data were often not reported. The meta-analysis was not possible due to the heterogeneity of outcomes. There was evidence that intervention effectiveness was modified by participants’ social characteristics. Minority ethnic groups were found to benefit more from interventions than majority ethnic groups. Single studies with variable quality showed that those with higher education, who were employed, and adolescents with divorced parents benefited more from interventions. The evidence for differences by age, gender, and health literacy was conflicting (eg, in some instances, older people benefited more, and in others, younger people benefited more). There was no evidence of differences in income, numeracy, or household size. Conclusions There was evidence that web-based self-care interventions for chronic conditions can be advantageous for some social groups (ie, minority ethnic groups, adolescents with divorced parents) and disadvantageous for other (ie, low education, unemployed) social groups who have historically experienced health inequity. However, these findings should be treated with caution as most of the evidence came from a small number of low-quality studies. The findings for gender and health literacy were mixed across studies on diabetes, and the findings for age were mixed across studies on asthma, COPD, and diabetes. There was no evidence that income, numeracy, or the number of people living in the household modified intervention effectiveness. We conclude that there appear to be interaction effects, which warrant exploration in future research, and recommend a priori consideration of the predicted interaction effects. Trial Registration PROSPERO CRD42017056163; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=56163
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Affiliation(s)
- Sophie Turnbull
- Centre for Academic Primary Care, Population Health Sciences, University of Bristol, Bristol, United Kingdom
| | - Christie Cabral
- Centre for Academic Primary Care, Population Health Sciences, University of Bristol, Bristol, United Kingdom
| | - Alastair Hay
- Centre for Academic Primary Care, Population Health Sciences, University of Bristol, Bristol, United Kingdom
| | - Patricia J Lucas
- School for Policy Studies, University of Bristol, Bristol, United Kingdom
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Malik FS, Senturia KD, Lind CD, Chalmers KD, Yi-Frazier JP, Shah SK, Pihoker C, Wright DR. Adolescent and parent perspectives on the acceptability of financial incentives to promote self-care in adolescents with type 1 diabetes. Pediatr Diabetes 2020; 21:533-551. [PMID: 31863541 PMCID: PMC7663046 DOI: 10.1111/pedi.12970] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2019] [Revised: 10/02/2019] [Accepted: 11/25/2019] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND An understanding of acceptability among potential intervention participants is critical to the design of successful real-world financial incentive (FI) programs. The purpose of this qualitative study was to explore adolescent and parent perspectives on the acceptability of using FI to promote engagement in diabetes self-care in adolescents with type 1 diabetes (T1D). METHODS Focus groups with 46 adolescents with T1D (12-17 years old) and 39 parents of adolescents with T1D were conducted in the Seattle metropolitan area. Semistructured questions addressed participants' current use of incentives to promote change in diabetes self-care and receptivity to a theoretical incentive program administered by a third-party. Qualitative data were analyzed and emergent themes identified. RESULTS Three thematic categories informed participant views about the acceptability of FI programs: (a) the extent to which using FIs in the context of diabetes management fit comfortably into a family's value system, (b) the perceived effectiveness for FIs to promote improved diabetes self-care, and (c) the urgent need for improved self-care due to the threat of diabetes-related health complications. These factors together led most parents and adolescents to be open to FI program participation. CONCLUSIONS The results from this qualitative study suggest that well-designed FI programs to support diabetes management are acceptable to families with adolescents with T1D. Additionally, the use of FIs may have the potential to support adolescents with T1D in developing strong self-care habits and ease the often-turbulent transition to independent self-care.
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Affiliation(s)
- Faisal S. Malik
- Department of Pediatrics, University of Washington, 1959 NE Pacific St, Seattle, WA, USA,Seattle Children’s Research Institute, 2001 8th Ave #400, Seattle, WA, USA
| | | | - Cara D. Lind
- Seattle Children’s Research Institute, 2001 8th Ave #400, Seattle, WA, USA
| | | | | | - Seema K. Shah
- Northwestern University, 680 N Lake Shore Drive, Chicago, IL, USA
| | - Catherine Pihoker
- Department of Pediatrics, University of Washington, 1959 NE Pacific St, Seattle, WA, USA,Seattle Children’s Research Institute, 2001 8th Ave #400, Seattle, WA, USA
| | - Davene R. Wright
- Department of Pediatrics, University of Washington, 1959 NE Pacific St, Seattle, WA, USA,Seattle Children’s Research Institute, 2001 8th Ave #400, Seattle, WA, USA
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Rash CJ, DePhilippis D. Considerations for Implementing Contingency Management in Substance Abuse Treatment Clinics: The Veterans Affairs Initiative as a Model. Perspect Behav Sci 2019; 42:479-499. [PMID: 31976446 DOI: 10.1007/s40614-019-00204-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Contingency management (CM) is an efficacious intervention for the treatment of substance use disorders that is widely applicable across a range of client populations and characteristics. Despite its strong evidence base, CM remains underutilized in real world practice. This article introduces CM for clinicians interested in adopting CM and briefly reviews this research evidence. In addition, CM protocols are described, with emphasis on the specific design considerations important to CM's efficacy. The recent Department of Veterans Affairs (VA) initiative, which represents the first successful large-scale implementation effort, is presented. It provides a model for the training and supervision components that may be critical to implementation with fidelity. Continued research in this area, as well as further demonstrations of successful dissemination and implementation, will be critical for improving the adoption of this intervention in clinical, nonresearch settings.
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Affiliation(s)
- Carla J Rash
- 1Calhoun Cardiology Center, University of Connecticut Health School of Medicine, 263 Farmington, Avenue (MC 3944), Farmington, CT 06030-3944 USA
| | - Dominick DePhilippis
- 2Center of Excellence in Substance Addiction Treatment and Education, Corporal Michael J. Crescenz Veterans Administration Medical Center, Perelman School of Medicine, Department of Veterans Affairs, Pennsylvania, PA USA
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Abstract
AIMS The aim of the study was to evaluate Facebook group as possible communication tool to improve glucose control in adolescents and young people with type 1 diabetes (T1D). METHODS This retrospective and cross-sectional study included 728 T1D patients (age 11-25) on continuous subcutaneous insulin infusion (CSII) or multiple daily injections (MDI) treated at the center for insulin pump and glucose sensor in Skopje from January 2012 to December 2017. Data were collected through the electronic medical record system and cross-sectional analysis (telephone, social media (Facebook and Viber) or email). Patients were analyzed in two groups: (a) non-Internet group, with 398 patients treated using standard medical protocol with regular clinic visits; (b) Internet group, with 330 patients who, besides standard medical protocol, were active members of a national closed Facebook group on diabetes. Both the non-Internet and Internet groups had regular visits every 2-3 months. Patients from the Internet group were members of the closed Facebook group "Diabetes Macedonia" and had an opportunity to interact with questions, answers, and comments on diabetes care. An additional analysis was performed of the Internet group on combined use of Facebook and Viber. Average HbA1c levels were compared in both groups. RESULTS Each patient from the Facebook group had 1.5 ± 3.5 posts per day. Hba1c was significantly lower in patients from the Internet group (7.1 ± 3.2%; 54 ± 35 mmol/mol) compared to patients from the non-Internet group (7.6 ± 2.8%; 60 ± 31 mmol/mol). CONCLUSIONS Social media like Facebook and Viber can be additional communication tool in adolescents and young people with T1D and can significantly lower HbA1c compared to patients without social media use. CSII patients are more likely to use both social media (Facebook and Viber) compared with MDI patients (Facebook only).
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Affiliation(s)
- Goran Petrovski
- University Clinic of Endocrinology, Diabetes and Metabolic Disorders, Skopje, Macedonia
- Goran Petrovski, MD, PhD, University Clinic of Endocrinology, Diabetes and Metabolic Disorders, Vodnjanska 17, 1000 Skopje, Macedonia.
| | - Marija Zivkovic
- University Clinic of Endocrinology, Diabetes and Metabolic Disorders, Skopje, Macedonia
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Knox ECL, Quirk H, Glazebrook C, Randell T, Blake H. Impact of technology-based interventions for children and young people with type 1 diabetes on key diabetes self-management behaviours and prerequisites: a systematic review. BMC Endocr Disord 2019; 19:7. [PMID: 30630442 PMCID: PMC6329145 DOI: 10.1186/s12902-018-0331-6] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Accepted: 12/21/2018] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND The role of technology in the self-management of type 1 diabetes mellitus (T1DM) among children and young people is not well understood. Interventions should aim to improve key diabetes self-management behaviours (self-management of blood glucose, insulin administration, physical activity and dietary behaviours) and prerequisites (psychological outcomes and HbA1c) highlighted in the UK guidelines of the National Institute for Health and Care Excellence (NICE) for management of T1DM. The purpose was to identify evidence to assess the effectiveness of technological tools in promoting aspects of these guidelines amongst children and young people. METHODS A systematic review of English language articles was conducted using the following databases: Web of Science, PubMed, Scopus, NUSearch, SAGE Journals, SpringerLink, Google Scholar, Science Direct, Sport Discus, Embase, Psychinfo and Cochrane Trials. Search terms included paediatric, type one diabetes, technology, intervention and various synonyms. Included studies examined interventions which supplemented usual care with a health care strategy primarily delivered through a technology-based medium (e.g. mobile phone, website, activity monitor) with the aim of engaging children and young people with T1DM directly in their diabetes healthcare. Studies did not need to include a comparator condition and could be randomised, non-randomised or cohort studies but not single-case studies. RESULTS Of 30 included studies (21 RCTs), the majority measured self-monitoring of blood glucose monitoring (SMBG) frequency, clinical indicators of diabetes self-management (e.g. HbA1c) and/or psychological or cognitive outcomes. The most positive findings were associated with technology-based health interventions targeting SMBG as a behavioural outcome, with some benefits found for clinical and/or psychological diabetes self-management outcomes. Technological interventions were well accepted by children and young people. For the majority of included outcomes, clinical relevance was deemed to be little or none. CONCLUSIONS More research is required to assess which elements of interventions are most likely to produce beneficial behavioural outcomes. To produce clinically relevant outcomes, interventions may need to be delivered for at least 1 year and should consider targeting individuals with poorly managed diabetes. It is not possible to determine the impact of technology-based interventions on insulin administration, dietary habits and/or physical activity behaviour due to lack of evidence.
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Affiliation(s)
- Emily C. L. Knox
- University of Nottingham, School of Health Sciences, Nottingham, UK
| | - Helen Quirk
- Sheffield Hallam University, Centre for Sport and Exercise Science, Sheffield, UK
| | - Cris Glazebrook
- University of Nottingham, School of Medicine, Nottingham, UK
| | - Tabitha Randell
- Department of Paediatric Endocrinology and Diabetes, Nottingham Children’s Hospital, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Holly Blake
- University of Nottingham, School of Health Sciences, Nottingham, UK
- NIHR Nottingham Biomedical Research Centre, Nottingham, UK
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16
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Chalew S, Gomez R, Vargas A, Kamps J, Jurgen B, Scribner R, Hempe J. Hemoglobin A1c, frequency of glucose testing and social disadvantage: Metrics of racial health disparity in youth with type 1 diabetes. J Diabetes Complications 2018; 32:1085-1090. [PMID: 30318164 DOI: 10.1016/j.jdiacomp.2018.02.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Revised: 02/04/2018] [Accepted: 02/06/2018] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Black youth with type 1 diabetes (T1D) have higher HbA1c than whites. To understand HbA1c differences, we examined the relationship of psycho-social factors and glucose testing with HbA1c. METHODS Glucose tests per day (BGs/d) and mean blood glucose (MBG) were calculated from meter data of youth self-identified as black (n = 33) or white (n = 53) with T1D. HbA1c, family income, insurance status, concentrated disadvantage (CDI), psychological depression (DSC), mother educational attainment (MEA), and insulin delivery method (IDM) data was were analyzed. RESULTS Black patients had significantly higher HbA1c, MBG and disadvantage measures compared to whites. BGs/d correlated with HbA1c, MBG, age and CDI. Race (p < 0.0158), age (p < 0.0001) and IDM (p < 0.0036) accounted for 50% of the variability (R2 = 0.5, p < 0.0001) in BGs/d. Regardless of age, black patients had lower BGs/d than whites. MBG (p < 0.0001) and BGs/d (p < 0.0001) accounted for 61% of the variance in HbA1c (p < 0.0001). CONCLUSIONS BGs/d is easily assessed and closely associated with HbA1c racial disparity. BGs/d is intricately linked with greater social disadvantage. Innovative management approaches are needed to overcome obstacles to optimal outcomes.
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Affiliation(s)
- Stuart Chalew
- Division of Endocrinology and Diabetes, Children's Hospital of New Orleans and The Louisiana State University Health Sciences Center, 200 Henry Clay Ave, New Orleans, LA 70118, USA.
| | - Ricardo Gomez
- Division of Endocrinology and Diabetes, Children's Hospital of New Orleans and The Louisiana State University Health Sciences Center, 200 Henry Clay Ave, New Orleans, LA 70118, USA
| | - Alfonso Vargas
- Division of Endocrinology and Diabetes, Children's Hospital of New Orleans and The Louisiana State University Health Sciences Center, 200 Henry Clay Ave, New Orleans, LA 70118, USA
| | - Jodi Kamps
- Department of Psychology, Children's Hospital of New Orleans, 200 Henry Clay Ave, New Orleans, LA 70118, USA
| | - Brittney Jurgen
- Department of Psychology, Children's Hospital of New Orleans, 200 Henry Clay Ave, New Orleans, LA 70118, USA
| | - Richard Scribner
- School of Public Health, The Louisiana State University Health Sciences Center, 433 Bolivar St, New Orleans, LA 70112, USA
| | - James Hempe
- Research Institute for Children, Children's Hospital of New Orleans and The Louisiana State University Health Sciences Center, 200 Henry Clay Ave, New Orleans, LA 70118, USA
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Stanger C, Lansing AH, Scherer E, Budney A, Christiano AS, Casella SJ. A Web-Delivered Multicomponent Intervention for Adolescents with Poorly Controlled Type 1 Diabetes: A Pilot Randomized Controlled Trial. Ann Behav Med 2018; 52:1010-1022. [PMID: 30418521 PMCID: PMC6230973 DOI: 10.1093/abm/kay005] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Background Type 1 diabetes is associated with significant mortality and economic cost. Management of type 1 diabetes involves completing multiple daily adherence behaviors, and many adolescents struggle with self-management and show poor glycemic control. Purpose The purpose was to conduct an unblinded pilot randomized controlled parallel-group study of a web-delivered multicomponent intervention targeting self-monitoring of blood glucose, working memory, and parent supervision of diabetes care among adolescents with type 1 diabetes. Intervention components included high magnitude incentives for adolescents and parents, motivational and cognitive behavioral therapy and working memory training for adolescents, and training in contingency contracting for parents. Methods Adolescents (N = 114) with poorly controlled type 1 diabetes were screened, and N = 61 were randomized using minimum likelihood allocation to usual care (usual care, N = 31) or to a 25-week/15-session web-delivered intervention (WebRx, N = 30). Results At the end of treatment, adolescents in WebRx had higher self-monitoring of blood glucose (d = 0.58) (primary outcome), better visual spatial working memory (d = 0.48) and inhibition (d = 0.98), and lower HbA1c (d = 0.45) than those in usual care. WebRx parents reported more frequent review of the adolescent's glucometer (d = 1.30) and reduced family conflict (d = 0.56). Between-condition differences were maintained 6 months later in self-monitoring of blood glucose (d = 0.42), visual spatial working memory (d = 0.76), family conflict (d = 0.50), and HbA1c (d = 0.44). Conclusions Results showing sustained effects on self-monitoring of blood glucose and HbA1c support moving forward with a larger trial to test this innovative web-delivered and multicomponent intervention. ClinicalTrials.gov Number (NCT01722643).
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Affiliation(s)
- Catherine Stanger
- Center for Technology and Behavioral Health, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
| | - Amy Hughes Lansing
- Center for Technology and Behavioral Health, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
| | - Emily Scherer
- Center for Technology and Behavioral Health, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
| | - Alan Budney
- Center for Technology and Behavioral Health, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
| | - Ann S Christiano
- Department of Pediatric Endocrinology, Children’s Hospital at Dartmouth, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| | - Samuel J Casella
- Department of Pediatric Endocrinology, Children’s Hospital at Dartmouth, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
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Duke DC, Barry S, Wagner DV, Speight J, Choudhary P, Harris MA. Distal technologies and type 1 diabetes management. Lancet Diabetes Endocrinol 2018; 6:143-156. [PMID: 28867311 DOI: 10.1016/s2213-8587(17)30260-7] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2017] [Revised: 06/21/2017] [Accepted: 07/03/2017] [Indexed: 02/09/2023]
Abstract
Type 1 diabetes requires intensive self-management to avoid acute and long-term health complications. In the past two decades, substantial advances in technology have enabled more effective and convenient self-management of type 1 diabetes. Although proximal technologies (eg, insulin pumps, continuous glucose monitors, closed-loop and artificial pancreas systems) have been the subject of frequent systematic and narrative reviews, distal technologies have received scant attention. Distal technologies refer to electronic systems designed to provide a service remotely and include heterogeneous systems such as telehealth, mobile health applications, game-based support, social platforms, and patient portals. In this Review, we summarise the empirical literature to provide current information about the effectiveness of available distal technologies to improve type 1 diabetes management. We also discuss privacy, ethics, and regulatory considerations, issues of global adoption, knowledge gaps in distal technology, and recommendations for future directions.
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Affiliation(s)
- Danny C Duke
- Department of Pediatrics, Oregon Health and Science University, Portland, OR, USA.
| | - Samantha Barry
- Department of Medicine, UMass Memorial Medical Center, Worcester, MA, USA
| | - David V Wagner
- Department of Pediatrics, Oregon Health and Science University, Portland, OR, USA
| | - Jane Speight
- The Australian Centre for Behavioural Research in Diabetes, Deakin University, and Diabetes Victoria, Melbourne, VIC, Australia
| | | | - Michael A Harris
- Department of Pediatrics, Oregon Health and Science University, Portland, OR, USA
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19
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Wong CA, Miller VA, Murphy K, Small D, Ford CA, Willi SM, Feingold J, Morris A, Ha YP, Zhu J, Wang W, Patel MS. Effect of Financial Incentives on Glucose Monitoring Adherence and Glycemic Control Among Adolescents and Young Adults With Type 1 Diabetes: A Randomized Clinical Trial. JAMA Pediatr 2017; 171:1176-1183. [PMID: 29059263 PMCID: PMC6583649 DOI: 10.1001/jamapediatrics.2017.3233] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
IMPORTANCE Glycemic control often deteriorates during adolescence and the transition to young adulthood for patients with type 1 diabetes. The inability to manage type 1 diabetes effectively during these years is associated with poor glycemic control and complications from diabetes in adult life. OBJECTIVE To determine the effect of daily financial incentives on glucose monitoring adherence and glycemic control in adolescents and young adults with type 1 diabetes. DESIGN, SETTING, AND PARTICIPANTS The Behavioral Economic Incentives to Improve Glycemic Control Among Adolescents and Young Adults With Type 1 Diabetes (BE IN CONTROL) study was an investigator-blinded, 6-month, 2-arm randomized clinical trial conducted between January 22 and November 2, 2016, with 3-month intervention and follow-up periods. Ninety participants (aged 14-20) with suboptimally controlled type 1 diabetes (hemoglobin A1c [HbA1c] >8.0%) were recruited from the Diabetes Center for Children at the Children's Hospital of Philadelphia. INTERVENTIONS All participants were given daily blood glucose monitoring goals of 4 or more checks per day with 1 or more level within the goal range (70-180 mg/dL) collected with a wireless glucometer. The 3-month intervention consisted of a $60 monthly incentive in a virtual account, from which $2 was subtracted for every day of nonadherence to the monitoring goals. During a 3-month follow-up period, the intervention was discontinued. MAIN OUTCOMES AND MEASURES The primary outcome was change in HbA1c levels at 3 months. Secondary outcomes included adherence to glucose monitoring and change in HbA1c levels at 6 months. All analyses were by intention to treat. RESULTS Of the 181 participants screened, 90 (52 [57.8%] girls) were randomized to the intervention (n = 45) or control (n = 45) arms. The mean (SD) age was 16.3 (1.9) years. The intervention group had significantly greater adherence to glucose monitoring goals in the incentive period (50.0% vs 18.9%; adjusted difference, 27.2%; 95% CI, 9.5% to 45.0%; P = .003) but not in the follow-up period (15.3% vs 8.7%; adjusted difference, 3.9%; 95% CI, -2.0% to 9.9%; P = .20). The change in HbA1c levels from baseline did not differ significantly between groups at 3 months (adjusted difference, -0.08%; 95% CI, -0.69% to 0.54%; P = .80) or 6 months (adjusted difference, 0.03%; 95% CI, -0.55% to 0.60%; P = .93). CONCLUSIONS AND RELEVANCE Among adolescents and young adults with type 1 diabetes, daily financial incentives improved glucose monitoring adherence during the incentive period but did not significantly improve glycemic control. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT02568501.
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Affiliation(s)
- Charlene A. Wong
- Department of Pediatrics, Duke Clinical Research Institute, Duke-Margolis Center for Health Policy, Duke University, Durham, North Carolina,Leonard Davis Institute of Health Economics, Center for Health Incentives and Behavioral Economics at the University of Pennsylvania, Philadelphia
| | - Victoria A. Miller
- Division of Adolescent Medicine, The Children’s Hospital of Philadelphia, Perelman School of Medicine and University of Pennsylvania, Philadelphia
| | - Kathryn Murphy
- Division of Pediatric Endocrinology, The Children’s Hospital of Philadelphia, Philadelphia
| | - Dylan Small
- Leonard Davis Institute of Health Economics, Center for Health Incentives and Behavioral Economics at the University of Pennsylvania, Philadelphia,Department of Statistics, The Wharton School, University of Pennsylvania, Philadelphia
| | - Carol A. Ford
- Division of Adolescent Medicine, The Children’s Hospital of Philadelphia, Perelman School of Medicine and University of Pennsylvania, Philadelphia
| | - Steven M. Willi
- Division of Pediatric Endocrinology, The Children’s Hospital of Philadelphia and University of Pennsylvania, Philadelphia
| | - Jordyn Feingold
- medical student, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Alexander Morris
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia
| | - Yoonhee P. Ha
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia
| | - Jingsan Zhu
- Leonard Davis Institute of Health Economics, Center for Health Incentives and Behavioral Economics at the University of Pennsylvania, Philadelphia,Perelman School of Medicine at the University of Pennsylvania, Philadelphia
| | - Wenli Wang
- Leonard Davis Institute of Health Economics, Center for Health Incentives and Behavioral Economics at the University of Pennsylvania, Philadelphia,Perelman School of Medicine at the University of Pennsylvania, Philadelphia
| | - Mitesh S. Patel
- Leonard Davis Institute of Health Economics, Center for Health Incentives and Behavioral Economics at the University of Pennsylvania, Philadelphia,Perelman School of Medicine at the University of Pennsylvania, Philadelphia,Department of Medicine, Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania,Health Care Management, The Wharton School, University of Pennsylvania, Philadelphia
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Affiliation(s)
- Shelagh Mulvaney
- School of Nursing, Vanderbilt University, Nashville, Tennessee2Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee3Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Joyce M. Lee
- Division of Pediatric Endocrinology, University of Michigan, Ann Arbor5Child Health Evaluation and Research Unit, Division of General Pediatrics, University of Michigan, Ann Arbor6Social Media Editor of JAMA Pediatrics
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Ridenour TA, Chen SHK, Liu HY, Bobashev GV, Hill K, Cooper R. The Clinical Trials Mosaic: Toward a Range of Clinical Trials Designs to Optimize Evidence-Based Treatment. J Pers Oriented Res 2017; 3:28-48. [PMID: 33569122 PMCID: PMC7842613 DOI: 10.17505/jpor.2017.03] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVE Dichotomizing clinical trials designs into nomothetic (e.g., randomized clinical trials or RCTs) versus idiographic (e.g., N-of-1 or case studies) precludes use of an array of hybrid designs and potential research questions between these extremes. This paper describes unique clinical evidence that can be garnered using idiographic clinical trials (ICTs) to complement RCT data. Proposed and illustrated herein is that innovative combinations of design features from RCTs and ICTs could provide clinicians with far more comprehensive information for testing treatments, conducting pragmatic trials, and making evidence-based clinical decisions. METHOD Mixed model trajectory analysis and unified structural equations modeling were coupled with multiple baseline designs in (a) a true N-of-1 pilot study to improve severe autism-related communication deficits and (b) a small sample preliminary study of two complimentary interventions to relieve wheelchair discomfort. RESULTS Evidence supported certain mechanisms of treatment outcomes and ruled out others. Effect sizes included mean phase differences (i.e., effectiveness), trajectory slopes, and differences in path coefficients between study phases. CONCLUSIONS ICTs can be analyzed with equivalent rigor as, and generate effect sizes comparable to, RCTs for the purpose of developing hybrid designs to augment RCTs for pilot testing innovative treatment, efficacy research on rare diseases or other small populations, quantifying within-person processes, and conducting clinical trials in many situations when RCTs are not feasible.
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Affiliation(s)
- Ty A Ridenour
- Research Triangle Institute, International, Research Triangle Park, North Carolina
- School of Pharmacy, University of Pittsburgh
| | - Szu-Han K Chen
- Department of Rehabilitation Science and Technology, University of Pittsburgh
| | - Hsin-Yi Liu
- Department of Rehabilitation Science and Technology, University of Pittsburgh
| | - Georgiy V Bobashev
- Research Triangle Institute, International, Research Triangle Park, North Carolina
| | - Katherine Hill
- Department of Communication Sciences and Disorders, University of Pittsburgh
| | - Rory Cooper
- Department of Rehabilitation Science and Technology, University of Pittsburgh
- Human Engineering Research Laboratories, Department of Veterans Affairs
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Liberman A, Drobnic Radobuljac M. Diabetes Technology and the Human Factor. Diabetes Technol Ther 2017; 19:S120-S127. [PMID: 28192026 DOI: 10.1089/dia.2017.2511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Alon Liberman
- 1 Jesse Z. and Sara Lea Shafer Institute for Endocrinology and Diabetes, National Center for Childhood Diabetes, Schneider Children's Medical Center of Israel , Petah Tikva, Israel
| | - Maja Drobnic Radobuljac
- 2 Faculty of Medicine, University of Ljubljana , Slovenia
- 3 Unit for Adolescent Psychiatry, Center for Mental Health, University Psychiatric Clinic , Ljubljana, Slovenia
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Ridenour TA, Wittenborn AK, Raiff BR, Benedict N, Kane-Gill S. Illustrating idiographic methods for translation research: moderation effects, natural clinical experiments, and complex treatment-by-subgroup interactions. Transl Behav Med 2016; 6:125-34. [PMID: 27012260 PMCID: PMC4807195 DOI: 10.1007/s13142-015-0357-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
A critical juncture in translation research involves the preliminary studies of intervention tools, provider training programs, policies, and other mechanisms used to leverage knowledge garnered at one translation stage into another stage. Potentially useful for such studies are rigorous techniques for conducting within-subject clinical trials, which have advanced incrementally over the last decade. However, these methods have largely not been utilized within prevention or translation contexts. The purpose of this manuscript is to demonstrate the flexibility, wide applicability, and rigor of idiographic clinical trials for preliminary testing of intervention mechanisms. Specifically demonstrated are novel uses of state-space modeling for testing intervention mechanisms of short-term outcomes, identifying heterogeneity in and moderation of within-person treatment mechanisms, a horizontal line plot to refine sampling design during the course of a clinic-based experimental study, and the need to test a treatment's efficacy as treatment is administered along with (e.g., traditional 12-month outcomes).
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Affiliation(s)
- Ty A Ridenour
- RTI, International, Research Triangle Park, NC, USA.
- University of Pittsburgh, Pittsburgh, PA, USA.
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